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City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
Name(s)
q50 1 -H - n faFL 3Zg5F�
Address
C7Z) 533o 0.772) 7( 3 - ( LIS- 9
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
-1 GL✓l-� 6Lt--•-c( c? oIIars ($ 2666. U° )
on this / 5' day of Mardi , 20/ 6 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit Li , Block 3 , Lot(s) l 3 4- I Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20) Opening & Closing /W 0 H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Temporary Marker Preparation & Installation
TOTAL $ 2-000. °O
` ~— ,r r WuticAlainfo
ature of Purchaser pity of Sebastian
The following documents were provided as Proof of
Residency:
I:\WW-DATA\Ms-Cemetery\RECEIPT.doc i3Z)P P''i �d
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 2
Name s I (e t, U Cash
Date 3 - (5 e 11 U Check#
U Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit-
001501 362100 Taxable Rent-
001501 362150 Non-Taxable Rent-
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001 218010 CobraServe _
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501 341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
Qo0/01() Cern efre-y lois _. Zoo.
343R:iO
Total Paid 1000.00
I ials
White-Dept.of Origin • Yellow-Finance • Pink-Applicant